Vaccines for preventing rotavirus diarrhoea: vaccines in use

Vaccines for preventing rotavirus diarrhoea: vaccines in use

Cochrane Database of Systematic Reviews 2012, Issue 11. Art. No.: CD008521. 

To read the full review please follow this link:  DOI: 10.1002/14651858.CD008521.pub3.

Karla Soares-Weiser1,, Harriet MacLehose2, Hanna Bergman1, Irit Ben-Aharon3, Sukrti Nagpal4, Elad Goldberg5,
Femi Pitan6, Nigel Cunliffe7

Enhance Reviews Ltd, Wantage, UK
The Cochrane Collaboration, Cochrane Editorial Unit, London, UK
Enhance Reviews, Kfar-Saba, Israel
Liverpool School of Tropical Medicine, Liverpool, UK
Beilinson Hospital, Rabin Medical Center, Department of Medicine E, Petah Tikva, Israel
Chevron Corporation, Lagos, Nigeria
University of Liverpool, Institute of Infection and Global Health, Faculty of Health and Life Sciences, Liverpool, UK

Rotavirus infection is a common cause of diarrhoea in infants and young children, and can cause mild illness, hospitalization, and death. Rotavirus infections results in approximately half a million deaths per year in children aged under five years, mainly in low- and middle-income countries. Since 2009, the World Health Organization (WHO) has recommended that a rotavirus vaccine be included in all national immunization programmes.

This review evaluates a monovalent rotavirus vaccine (RV1; Rotarix, GlaxoSmithKline Biologicals) and a pentavalent rotavirus vaccine (RV5; RotaTeq, Merck & Co., Inc.). These vaccines have been evaluated in several large trials and are approved for use in many countries. No trials of the Lanzhou lamb rotavirus vaccine (LLR; Lanzhou Institute of Biomedical Products) were found; this vaccine is used in China only. The review includes 41 trials with 186,263 participants; all trials compared a rotavirus vaccine with placebo. The vaccines tested were RV1 (29 trials with 101,671 participants) and RV5 (12 trials with 84,592 participants). The trials took place in a number of worldwide locations.

In the first two years of life, RV1 prevented more than 80% of severe cases of rotavirus diarrhoea in low-mortality countries, and at least 40% of severe rotavirus diarrhoea in high-mortality countries. Severe cases of diarrhoea from all causes (such as any viral infection, bacterial infections, toxins, or allergies) were reduced after vaccination with RV1 by 35 to 40% in low-mortality countries, and 15 to 30% in high-mortality countries.

In the first two years of life, RV5 reduced severe cases of rotavirus diarrhoea by more than 80% in low-mortality countries, and by 40 to 57% in high-mortality countries. Severe cases of diarrhoea from all causes were reduced by 73% to 96% in low-mortality countries, and 15% in high-mortality countries, after vaccination with RV5. Diarrhoea is more common in high-mortality countries, so even modest relative effects prevent more episodes in this population. The vaccines when tested against placebo gave similar numbers of adverse events such as reactions to the vaccine, and other events that required discontinuation of the vaccination schedule.